What is self-directed health?

The Undoctored Health Blog is all about self-directed health.

Let me explain.

I’m going to make a bold proposal, one you may find farfetched, even irresponsible.

I propose that much of human health can be managed without a doctor or hospital, but by individuals, on their own.

Sure, you could remove a wart using the cider vinegar recipe your grandmother gave you⎯big deal. But I’m referring to something much more substantial. And I don’t mean removing your own appendix, or self-splinting a leg fracture in your garage.

What I mean is that many health conditions can be safely, effectively, and inexpensively managed by an individual without a doctor’s guidance, without a doctor’s diagnosis, and without need for prescription medication.

It’s already happening. And it’s already happening on an incredible scale, not just by the eccentric doctor-phobe bearing acupuncture needles along meridian lines. It is a philosophy already embraced by tens of millions of people, although they may have done so unknowingly.

I call this phenomenon self-directed health: health practices and disease treatment that are self-managed.

You might already recognize a rudimentary form of self-directed health in its predecessor, “wellness,” the healthy-eating, exercise-break, check-your-blood-pressure and know-your-cholesterol practices followed at workplaces to reduce healthcare costs. But the concept is evolving rapidly from this humble start. And it’s going to grow much bigger.

To view evidence of self-directed health at work on a large scale, look no farther than nutritional supplements, the wildly popular $21 billion confirmation that people desire self-managed health solutions. Though we may dispute the wisdom and effectiveness of some of it, there is no doubt that options in nutritional supplements have exploded over the past two decades⎯and the public has embraced them enthusiastically. Lax regulation imposed by the 1994 Dietary Supplement Health and Education Act has allowed the definition of “nutritional supplement” to be stretched to the limit and includes obviously non-nutritional (though still potentially interesting) products like the hormones pregnenolone, dehydroepiandrosterone (DHEA), and melatonin to be sold on the same shelf as vitamin C, “nutritional supplements” that fill the growing public appetite for self-directed health.

Though still in its infancy, direct-to-consumer access to medical imaging is yet another facet of the phenomenon of self-directed health. Today, it is possible to diagnose your own coronary disease (CT heart scan), measure bone density for osteoporosis (DEXA, ultrasound, or bone densitometry), or quantify the severity of carotid atherosclerosis (ultrasound) with tests available to the consumer⎯directly, without a doctor’s involvement. A number of market forces in healthcare (including increasing exposure to large insurance deductibles) are converging to make direct-to-consumer medical imaging an appealing option.

Direct-to-consumer laboratory testing, a silent but substantial phenomenon, has emerged only in the last few years, largely in response to physician reluctance to order tests requested by individuals eager to explore health. Cost awareness to the price of lab testing is growing as more people are being exposed to health costs through larger insurance deductibles. The competitive pricing that develops naturally in a direct-to-consumer retail service yields substantial cost savings. (50% is not uncommon.) A mind-boggling array of self-directed tests is now available, from advanced markers for heart disease, to genetic cancer markers, to hormonal assessments.

Undoctored Health is going to chart these explorations in self-directed health. I invite you to follow along.


The irresistible itch

The prospect of self-managing aspects of health is tantalizing to a lot of people.

Self-directed health conceivably means that cholesterol abnormalities can be identified and managed without a doctor; blood pressure reduced without seeing a doctor; early osteoporosis corrected using commonly available nutritional supplements and exercise; vitamin D blood levels can be self-measured and self-corrected; low thyroid underlying fatigue can be identified and corrected.

When people begin to realize just how much they are capable of in directing their own health, an amazing spark of interest ignites and they develop a deep fascination with learning more⎯a stark contrast with the conventional health interaction.

Self-directed health is a phenomenon that will stretch far and wide into human health. It will encompass preventive practices, diagnostic testing, and therapeutic strategies. Self-directed health will grow to include heart disease, cancer prevention and identification, diabetes and pre-diabetes identification and management; osteoporosis identification and correction; genetic testing; issues peculiar to men, issues peculiar to women.

Self-directed health will dramatically shift the landscape of healthcare, change the economics of payment for healthcare, and revolutionize health for millions. This is not a concept, but the start of a movement.

Critics will say this is hazardous. In our drive-thru, just-add-water-and-microwave world of instant gratification, critics will warn that potential for danger is prohibitive. They fear that people will misdiagnose, misinterpret, or fail to recognize health conditions, choose the wrong diagnostic test, institute the wrong treatment. Chaos will result, unnecessary or unwise treatments instituted.

I disagree.

Surely, increased freedom necessitates increased responsibility. Boundaries will need to be established, rules followed, guidelines provided, guidance available.

But I predict that self-directed health will, on the whole, improve health⎯enormously.


The investment industry: Model of self-directed behavior

Up until the 1980s, individual investment was managed by a stockbroker or other money manager.

Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, bonds, and derivatives.

Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. They had no choice but to engage the services of a professional investor.

That has all changed. Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that were not even in existence 20 years ago. Companies that serve individual investors like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the near future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will spread more vigorously through our lives, since health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need. Nonetheless, the emergence of health directed by the individual, just as the emergence of self-directed investment, will explode over the coming years.


Even monkeys do it

“Chausiku goes directly to and sits down in front of a shrub and pulls down several new growth branches about the diameter of my little finger. She places them all on her lap and removes the bark and leaves of the first branch to expose the succulent inner pith. She then bites off small portions and chews on each for several seconds at a time. By doing this, she makes a conspicuous sucking sound as she extracts and swallows the juice, spitting out most of the remaining fiber. This continues for 17 minutes, with short breaks as she consumes the pith of each branch in the same manner.”

Michael A. Huffman, PhD, a primatologist at the Primate Research Institute, Kyoto University, observing the chimpanzee, Chausiku, medicating herself in the jungles of Tanzania.


Dr. Michael Huffman’s description of Chausiku documents an extraordinary example of animal self-medication, unaided by human direction. In this instance, the chimpanzee, weak, clutching her back in pain, and listless, was ingesting the leaves of the plant, Vernonia amygdalina, to purge an intestinal parasite. She recovered by the next morning.

Vernonia leaves have since been found to contain over a dozen potential anti-parasitic compounds.

Perhaps if chimps can do it, we can, too.

On the news, you hear about a new study that showed reduction in heart attack in people who eat fish or take fish oil. Intrigued, you go to the health food store and purchase a bottle of fish oil capsules.

Believe it or not, you have just participated in the new exploding phenomenon that I call self-directed health, taking part in your own health based on an information exchange that does not involve your doctorundoctored.

It certainly doesn’t end at taking fish oil to reduce heart attack risk. There is a revolution underway that will help identify health conditions before they require a doctor, locate treatments that stop or reverse the condition without medication, share experiences with others with similar concerns, help people become far more healthy than ever believed possiblecertainly healthier than the hands off, call-me-when-you-hurt approach of conventional medicine. In fact, incredible health is achievable for most of us free of medication, managed under self-direction.

Even 10 years ago, the prospect of self-directing aspects of health would have been difficult. In 10 short years, the resources available to us have exploded. And they will continue to increase at an exponential rate.



Why self-directed health is necessary

While seizing control over health to reach new heights of energy, well-being, and freedom from disease is wonderfully enticing, spiraling healthcare costs make self-directed health a necessity.

The self-directed health phenomenon will be catalyzed as individuals bear more healthcare costs through larger insurance deductibles, flex-spending and medical savings accounts. As control over more of the healthcare dollar is returned to that of the health consumer, they will seek to spend their dollars wisely and look for solutions that don’t involve costly conventional medical answers like medication and procedures.

Cost savings will be realized, as consumers are more likely to engage in preventive care and avoid expensive doctors, prescriptions, and hospital services.

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